How to Choose Your Doctor

In this issue of HONOLULU Magazine, you’ll find a list compiled by Best Doctors in America. The organization asks doctors in the United States and Canada whom they’d want to treat them if they were sick. While popular with health consumers, the Best Doctors list is, at best, regarded by Hawai‘i doctors with suspicion.

“This list is a popularity contest, like American Idol,” comments Dr. Stephen Arnold, despite being selected for the list for four years running. He adds modestly, “I know plenty of doctors in town who are smarter and kinder than I, and who are not on the list.” At the same time, “there is at least one doctor on that list who I think should not be there.”

One might say that Arnold protests too much. Indeed, he is widely regarded in the medical community as a “doctor’s doctor,” caring for many doctors and their families. Why is Arnold, and other doctors on the list, so respected by their peers? Is it because he starts seeing patients at 6:30 in the morning and stays until 8 or 9 p.m. in his office dictating notes? Is it because he trained at Cornell? Or is it because he has been practicing for more than 25 years in one location?

How does one become a doctor’s doctor? It is interesting to note that, while marketing experts, health plans and even the government have extensively studied how patients choose doctors, how doctors choose doctors has hardly been studied at all. Is there something patients can learn here?

How Do Doctors Choose Doctors?

At first glance, it seems that doctors are not particularly choosy when it comes to selecting their own doctors.

“I chose Dr. Pien because he worked right next door,” remembers Arnold. “I chose Dr. Arnold because he was my wife’s doctor,” Dr. Robbins says.

When pressed further, though, my colleagues added that, “Dr. Pien has a brilliant mind, and is also very thorough.”

“Dr. Arnold is easy to communicate with.”

Most doctors focus on the technical aspect of medicine: being as shrewd and thorough as Sherlock Homes, making the right diagnoses and keeping up with new findings. As Dr. Edwin Cadman, dean of the University of Hawai‘i Medical School, puts it, “A doctor must have an outstanding base of knowledge. Patients do not know disease processes. They relay the information to the doctor. The doctor must then analyze the data and make the right diagnosis.”

How Patients Usually Choose Doctors

On the other hand, patients seem to assume that the doctor is competent and focus instead on the doctor’s ethics. Patients want doctors who put the patient’s interests first, not the doctor’s interest, not the hospital’s, not the HMO’s interest. In this age of “managed care” (managed by whom?), 90 percent of patients still believe that their doctors put the patient’s interest first. However, more than 40 percent of patients believe that their doctors’ decisions are partly influenced by HMOs, whether the patients are enrolled in managed care or not.

This tarnished reputation was earned by doctors in the 1990s when they signed up to be “gatekeepers” for HMOs. In the past five years, managed care has been rejected by a popular revolt of patients. Fortunately, doctors still rank second-highest in the most recent Gallup poll of professions in terms of honesty and ethics, right behind nurses who did not sign up to be gatekeepers. In the same Gallup poll, HMO managers were ranked last for honesty and ethics.